Lawsuit alleges hundreds of millions of dollars in overbilling

In 2015, a whistleblower filed a qui tam lawsuit against Epic Systems for violating the False Claims Act, alleging that Epic caused the billing systems to double-bill the government for anesthesia services. The plaintiff-whistleblower (“Relator”), Geraldine Petrowski, worked at WakeMed Health in Raleigh, North Carolina between 2008 and 2014 and served as the liaison for the hospital’s Epic implementation. Petrowski alleges that the billing system overbilled the government for hundreds of millions of dollars. The Department of Justice declined to intervene in the case. However, the Relator has decided to move forward without the government, resulting in the case becoming public. As hospital liaison for the Epic implementation, Petrowski claims to have observed “major concerns” about incorrect billing. These concerns led to Epic billing software defaults that charged for both the applicable anesthesia “base units” provided on a procedure and the actual time taken for the procedure. As a result, payors were overcharged for anesthesia. According to the complaint filed, Medicare adjusted its payment approach to anesthesia services in 2012 to require physicians to bill for the actual time on a procedure instead of 15-minute blocks of time reflected within the “base units.” The Relator stated she provided examples to Epic representatives that illustrated the double-billing practice, and the company initially ignored her complaints. Epic agreed to fix the software after forcing the issue, but only for the WakeMed Health facility.

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